GIULIANO GENEROSO
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- The association between triglyceride-rich lipoproteins, circulating leukocytes, and low-grade inflammation: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)(2023) CESENA, Fernando Yue; GENEROSO, Giuliano; SANTOS, Raul D.; PEREIRA, Alexandre Costa; BLAHA, Michael J.; JONES, Steven R.; TOTH, Peter P.; LOTUFO, Paulo A.; BITTENCOURT, Marcio Sommer; BENSENOR, Isabela M.Background: Experimental studies have linked triglyceride-rich lipoproteins (TRLs) to inflamma-tion, but the extent of this phenomenon in vivo has not been completely elucidated.Objective: We investigated the association between TRL subparticles and inflammatory markers (circulating leukocytes, plasma high-sensitivity C-reactive protein [hs-CRP], and GlycA) in the general population.Methods: This was a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TRLs (number of particles per unit volume) and GlycA were measured by nuclear mag-netic resonance spectroscopy. The association between TRLs and inflammatory mark ers w as determined by multiple linear regression models adjusted for demographic data, metabolic conditions, and lifestyle factors. Standardized regression coefficients (beta) with 95% confidence intervals are reported. Results: The study population comprised 4,001 individuals (54% females, age 50 +/- 9 years). TRLs, especially medium and large subparticles, were associated with GlycA (beta 0.202 [0.168, 0.235], p < 0.001 for total TRLs). There was no association between TRLs and hs-CRP (beta 0.022 [-0.011, 0.056], p = 0.190). Medium, large, and very large TRLs were associated with leukocytes, with stronger connections with neutrophils and lymphocytes than monocytes. When TRL subclasses were analyzed as the proportion of the total pool of TRL particles, medium and large TRLs were positively related to leukocytes and GlycA, whereas smaller particles were inversely associated.Conclusions: There are different patterns of association between TRL subparticles and inflammatory markers. The findings support the hypothesis that TRLs (especially medium and larger subparticles) may induce a low-grade inflammatory environment that involves leukocyte activation and is captured by GlycA, but not hs-CRP.(c) 2023 National Lipid Association.
- Dietary patterns and subclinical atherosclerosis incidence and progression: Results from ELSA-Brasil(2023) ALVES, Mariane de A.; MIRANDA, Andreia M.; CACAU, Leandro T.; LEVY, Jessica; GENEROSO, Giuliano; BITTENCOURT, Marcio S.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; MARCHIONI, Dirce M.Background and aims: Cardiovascular disease (CVD) is the main cause of disease burden worldwide. Coronary artery calcification (CAC) score is a subclinical atherosclerosis marker able to predict the risk of CVD in asymptomatic patients, and few studies have investigated the association between dietary patterns (DP) and CAC score prospectively. Thus, the aim of this study was to estimate the association between baseline DP and CAC score incidence and progression on the ELSA-Brasil cohort. Methods and results: This study is a longitudinal prospective analysis of the ELSA-Brasil participants who underwent a CAC exam on baseline and follow-up (n = 2,824). CAC incidence was defined as a baseline CAC score equal to zero (n = 2,131) and subsequent follow-up CAC score greater than zero. CAC progression was defined according to the Hokanson method for the individuals who presented a CAC score greater than zero at the baseline (n = 639). Dietary data were assessed at the baseline using a food frequency questionnaire (FFQ), and factor analysis was applied to identify DP. Poisson regression models with robust variance and linear regression models were applied to estimate the association between baseline DP and CAC incidence and progression. The incidence of CAC was 14.6%, while 60.3% of the individuals presented CAC progression. Three DP were identified: convenience, Brazilian traditional, and prudent. We did not find a significant association between baseline DP and CAC incidence or progression. Conclusion: Our findings from this longitudinal prospective analysis showed that baseline DP are not associated with CAC incidence or progression. & COPY; 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University.
- Validation of the North America expert consensus statement on reporting CT findings for COVID-19 in individuals with lung cancer(2022) PEIXOTO, D.; NEVES, Y. C. S.; GENEROSO, G.; LOUREIRO, B. M. C.; CALLIA, J. P. B.; ANASTACIO, V. M.; ALVES, J. L.; OSHIRO, E. M.; LIMA, L. R.; SAWAMURA, M. V. Y.; AUAD, R. V.; BITTENCOURT, M. S.; ABDALA, E.; IBRAHIM, K. Y.The aim of our study was to validate the use of the standardized Radiological Society of North America (RSNA) reporting system in individuals with known lung cancer who presented to the emergency department with suspected COVID-19. We included patients aged 18 years or older from the Cancer Institute of the State of Sao Paulo (ICESP) with a confirmed diagnosis of lung cancer, admitted to the emergency department and undergoing chest computed tomography (CT) for suspicion of COVID-19. Comparison between SARS-CoV2 RT-PCR across RSNA categories was performed in all patients and further stratified by diagnosis of lung cancer progression. Among 58 individuals included in the analysis (65 +/- 9 years, 43% men), 20 had positive RT-PCR. Less than a half (43%) had no new lung findings in the CT. Positive RT-PCR was present in 75% of those with typical findings according to RSNA and in only 9% when these findings were classified as atypical or negative (Po0.001). Diagnostic accuracy was even higher when stratified by the presence or absence of progressive disease (PD). Extent of pulmonary inflammatory changes was strongly associated with higher mortality, reaching a lethality of 83% in patients with >25% of lung involvement and 100% when there was >50% of lung involvement. The lung involvement score was also highly predictive of prognosis in this population as was reported for non-lung cancer individuals. Collectively, our results demonstrated that diagnostic and prognostic values of chest CT findings in COVID-19 are robust to the presence of lung abnormalities related to lung cancer.
- Combined Association of Novel and Traditional Inflammatory Biomarkers With Carotid Artery Plaque: GlycA Versus C-Reactive Protein (ELSA-Brasil)(2023) TEBAR, William R.; MENEGHINI, Vandrize; GOULART, Alessandra C.; SANTOS, Itamar S.; SANTOS, Raul D.; BITTENCOURT, Marcio S.; GENEROSO, Giuliano; PEREIRA, Alexandre C.; BLAHA, Michael J.; JONES, Steven R.; TOTH, Peter P.; OTVOS, James; LOTUFO, Paulo A.; BENSENOR, Isabela M.Elevated levels of glycoprotein acetylation (GlycA) and C-reactive protein (CRP) have been associated with carotid artery plaque (CAP). However, it is not yet established if elevations in both inflammatory biomarkers provide incremental association with CAP. This study aimed evaluate the cross-sectional association of high CRP and GlycA with CAP at baseline participants from the ELSA-Brasil adult cohort. Participants with information on CRP, GlycA, and CAP with neither previous cardiovascular disease nor CRP >10 mg/ L were included. High GlycA and CRP were defined as values within upper quintile and >3 mg/L, respectively. Participants were classified into 4 groups: 1. nonelevated CRP/ GlycA (reference group); 2. elevated CRP alone; 3. elevated GlycA alone; and 4. both elevated. The analysis included 4,126 participants with median age of 50 years-old, being 54.2% of women. Prevalence of CAP was 36.1%. Participants with high CRP had the highest frequency of obesity, whereas participants with high GlycA presented higher cardiovascular risk factor burden and were more likely to have CAP than the reference group (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.11 to 1.73), persisting after multivariable adjustment (OR 1.37, 95% CI 1.02 to 1.83). Participants with both elevated CRP and GlycA were more likely to have CAP in crude (OR 1.35, 95% CI 1.10 to 1.65) but not in adjusted models. The findings suggest potential different biologic pathways between inflammation and carotid atherosclerosis: high GlycA was associated with CAP whereas high CRP was more associated with obesity. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;204:140-150)
conferenceObject The Association of Triglyceride-Rich Lipoproteins With Cognitive Function: ELSA-Brazil (the Brazilian Longitudinal Study of Adult Health)(2022) HAMANDI, Mohanad; GENEROSO, Giuliano; SUEMOTO, Claudia K.; BENSANOR, Isabela M.; KULKARNI, Krishnaji; SANTOS, Raul; JONES, Steven R.; BLAHA, Michael J.; TOTH, Peter P.; LOTUFO, Paulo A. Andrade; BITTENCOURT, Marcio S.- Percentiles of predicted 10-year cardiovascular disease risk by sex and age in Brazil and their association with estimated risk of long-term atherosclerotic events(2023) CESENA, Fernando Yue; GENEROSO, Giuliano; SANTOS, Itamar de S.; DUNCAN, Bruce B.; RIBEIRO, Antonio Luiz P.; BRANT, Luisa Caldeira; MILL, Jose Geraldo; PEREIRA, Alexandre C.; BITTENCOURT, Marcio Sommer; SANTOS, Raul D.; LOTUFO, Paulo A.; BENSENOR, Isabela M.Objective: Expressing the cardiovascular disease (CVD) risk in relation to peers may complement the estimation of absolute CVD risk. We aimed to determine 10-year CVD risk percentiles by sex and age in the Brazilian population and evaluate their association with estimated long-term atherosclerotic CVD (ASCVD) risk.Methods: A cross-sectional analysis of baseline data from the ELSA-Brasil study was conducted in individuals aged 40-74 years without prior ASCVD. Ten-year CVD risk and long-term ASCVD risk were estimated by the WHO risk score and the Multinational Cardiovascular Risk Consortium tool, respectively. Ten-year risk percentiles were determined by ranking the calculated risks within each sex and age group.Results: Ten-year CVD risk versus percentile plots were constructed for each sex and age group using data from 13,364 participants (55% females; median age, 52 [IQR, 46-59] years). Long-term ASCVD risk was calculated in 12,973 (97.1%) participants. Compared to individuals at the <25th risk percentile, those at the >= 75th percentile had a greater risk of being in the highest quartile of long-term risk (ORs [95% CIs] 6.57 [5.18-8.30] in females and 11.59 [8.42-15.96] in males) in regression models adjusted for age, race, education, and 10-year CVD risk. In both sexes, the association between risk percentile and long-term risk weakened after age 50. A tool for calculating 10-year CVD risk and the corresponding percentile is available at https://bit.ly/3CzPUi6.Conclusions: We established percentiles of predicted 10-year CVD risk by sex and age in the Brazilian population, which independently reflect the estimated long-term ASCVD risk in younger individuals.
- The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)(2024) SPILACK, Aida de Melo; GOULART, Alessandra C.; JANOVSKY, Carolina C. P. S.; ALMEIDA-PITTITO, Bianca de; LOTUFO, Paulo A.; BITTENCOURT, Marcio Sommer; GENEROSO, Giuliano; SANTOS, Itamar de Souza; BENSENOR, Isabela M.Objective: We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods: CAC was measured using a 64-detector computed tomographic scanner.The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as beta (95%CI) in linear models after multivariable adjustment for confounders. Results: We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (beta, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion: In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings.